目的

报道1例病情较重的静脉内平滑肌瘤病(intravenous leiomyomatosis,IVL)案例,采用机器人手术多学科协作成功完成诊治过程。

方法

解放军总医院第一医学中心妇科2023年8月收治静脉内平滑肌瘤病患者1例,该患者多发子宫肌瘤,子宫体积巨大,静脉内平滑肌瘤病灶累及左侧宫旁、盆底血管,瘤栓向上沿左侧卵巢静脉、左肾静脉、下腔静脉至右心房。经妇科、泌尿外科、心外科、超声科、放射诊断科、麻醉科等相关科室联合会诊,采用机器人手术多学科协作彻底切除病灶,手术用时356 min,出血量500 ml。

结果

该患者围手术期无严重并发症发生,恢复顺利,于术后12 d好转出院,随访1年无复发及远期并发症发生。

结论

本病例采用机器人手术多学科协作一期手术彻底切除IVL病灶,微创手术能够令更多IVL患者获益,其中机器人手术系统的优势与高水平的多学科协作令此类复杂、困难的手术治疗得以实现。

Objective

To report a case of severe intravenous leiomyomatosis (IVL) managed through robotic surgery and multidisciplinary collaboration.

Methods

In Aug. 2023, a patient with intravenous leiomyomatosis was admitted to the First Medical Center of Chinese PLA General Hospital. The patient presented with multiple uterine leiomyomas and a markedly enlarged uterine corpus. The IVL lesion involved the left parametrium and pelvic floor vasculature, with tumor thrombus extending upward along the left ovarian vein, left renal vein, inferior vena cava, and terminating in the right atrium. A multidisciplinary consultation was convened, involving departments of gynecology, urology, cardiothoracic surgery,ultrasound, radiology, anesthesiology, and other relevant specialties. The lesion was completely resected through robotic surgery and multidisciplinary collaboration. The operative duration was 356 minutes, with an estimated blood loss of 500 ml.

Results

The patient experienced no severe complications during the perioperative period and had an uneventful recovery. She was discharged in improved condition 12 days postoperatively and remained free of recurrence and long-term complications during a 1-year follow-up period.

Conclusion

This case highlights the successful management of IVL through robotic surgery and multidisciplinary collaboration, achieving complete resection of the lesion in a single surgical stage.Minimally invasive surgery, particularly leveraging the advantages of the robotic surgical system and high-level multidisciplinary collaboration, has enabled the effective treatment of such complex and challenging cases.